Myopia News Briefs

Eye Health Organizations Unveil Recommendations in Response to Myopia Epidemic

January 11, 2021

JACKSONVILLE, Florida  – Johnson & Johnson Vision announced new guidance for eye care professionals to assess, monitor, and treat myopia in children. The new guide, Managing Myopia: A Clinical Response to the Growing Epidemic is the result of a year of collaboration with some of the world’s leading optometric organizations, including the American Optometric Association, the American Academy of Optometry, the Association of Schools and Colleges of Optometry, and the Singapore Optometric Association. This marks the latest milestone to address the growing myopia epidemic following the establishment of a strategic research partnership between Johnson & Johnson Vision, the Singapore National Eye Centre, and the Singapore Eye Research Institute.

A chronic and progressive disease, myopia poses the biggest eye health threat of the 21st Century.1 Myopia in all children should be addressed, but when myopia onset occurs in those younger than 12 years of age, it carries a significantly increased risk of developing high myopia later in life.2 Additionally, half of the world’s population is projected to be myopic by 2050 with one billion people expected to have high myopia.3

“As optometrists, we have been concerned for the eye health of children and the trajectory of myopia on a global level, and COVID-19 has only increased our concern,” said Noel Brennan, MScOptom, PhD, FAAO, and Clinical Research Fellow, Myopia Control Platform, Johnson & Johnson Vision. “Johnson & Johnson Vision in partnership with leaders in optometry has created this new myopia management guide as a clinical response to address the rising rates of myopia globally and solidify our collective commitment to combating myopia as a major threat to our children’s eye health.”

Myopia may be caused by both environmental and genetic factors, and it increases the risk of myopic macular degeneration (MMD),4 staphyloma,5 retinal detachment,6 primary open-angle glaucoma,7 and cataracts8 – all of which can lead to visual impairment and blindness.9 The new recommendations bring greater awareness to the urgent need to assess, monitor, and treat myopia in children.

“Doctors of optometry are on the primary eye care frontlines battling this crisis, and it is imperative to deliver forward-looking clinical information, grounded in emerging data and first-hand, real-world experience,” said Robert Layman, OD, President-Elect, American Optometric Association. “In collaborating with Johnson & Johnson Vision and this group of leaders, we are providing doctors with information that will enable them to deliver individualized patient care that will support the patient throughout their childhood and into adulthood.”

Managing Myopia: A Clinical Response to the Growing Epidemic adds to the collective awareness, research, and understanding of myopia and provides a research-based rationale for how and why we need to prioritize the eye health of children.

“The new recommendations to help slow the progression of myopia are a great step forward for our children,” said Ken Tong, BSc Optom, President, Singapore Optometric Association. “Traditional ways have taught us to simply change glasses upon prescription updates. However, this is a dangerous act as there is bound to be a rapid progression of myopia during childhood. This situation is too common in clinic, where our practitioners see myopia in children increase over time. An increase in myopia compromises the structure and health of the eye, meaning a greater risk of eye disease and vision loss. As such, myopia control methods must be implemented to curb preventable eye diseases from progressing. If there is no intervention in a myopic child’s visual system, myopia will continue to worsen and present greater threats to eye health over an individual’s lifetime.”

Key points for eye care professionals and patients to consider based on the new guide include:

  • Monitor for myopia in children: Based on guidelines from the American Optometric Association, children need eye examinations between 6-12 months of age and at least once between 3-5 years of age, then annually through age 17.
  • Secure early treatment: The defining indication for beginning treatment is the onset of myopia. Identifying and treating myopia as early as possible is critical to slow progression.
  • Find the right therapy: The right treatment for a myopic child depends on a combination of the practitioner’s advice, parents’ preference, and the child’s capabilities and maturity.10 Knowing efficacy is similar across treatments, practitioners, and families can choose the best option for each patient, including orthokeratology,11 soft multifocal contact lenses,12 myopia control spectacles,13 or atropine eye drops.14
  • Monitoring myopia progression: Frequent monitoring, at least every six months once treatment is established, helps reduce barriers to use, identify non-compliant or risky behaviors, and address any problems as early as possible. Axial length and cycloplegic refractive error may be measured at frequent intervals but should be evaluated over at least one year before considering therapeutic changes or supplemental therapy because progession can vary seasonally.15
  • Communicating myopia control efficacy: Myopia control treatment effect tends to be more of an absolute effect than a proportional effect.16 The best descriptor of myopia control efficacy is the cumulative absolute reduction in elongation or refractive error (ie. total mm or D).

 Managing Myopia: A Clinical Response to the Growing Epidemic is available to download here.

[1] JJV data on file: Myopia Compendium.

[2] Hu Y, Ding X, Guo X, et al. Association of Age at Myopia Onset with Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol 2020.

[3] Holden et al Ophthalmol 2016; 123: 1036.

4] Ohno-Matsui K et al. Updates of Pathologic Myopia. Prog Retin Eye Res 2016;52:156-87.

[5] Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia. Prog Retin Eye Res 2019;70:99-109

[6] Mitry D et al. The  Epidemiology of Rhegmatogenous Retinal Detachment: Geographical Variation and Clinical Associations. Br J Ophthalmol 2010;94:678-84.

[7] Marcus MW et al. Myopia as a Risk Factor for Open-Angle Glaucoma: A Systematic Review and  Meta-Analysis. Ophthalmol 2011;118:1989-94.

[8] Pan CW et al. Myopia and Age-Related Cataract: A Systematic Review and Meta-Analysis. American Journal of Ophthalmology 156.5 (2013): 1021-1033

[9] Fredrick, D. R. (2002). Myopia. BMJ, 324(7347), 1195-1199. doi:10.1136/bmj.324.7347.1195.

[10] Gifford KL, Richdale K, Kang P, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci 2019;60:M184-203.

[11] Cho P, Cheung SW. Retardation of Myopia in Orthokeratology (Romio) Study: A 2-Year Randomized Clinical Trial. Invest Ophthalmol Vis Sci 2012;53:7077-85.

[12] Chamberlain P, Peixoto-de-Matos SC, Logan NS et al. A 3-Year Randomized Clinical Trial of Misight Lenses for Myopia Control. Optom Vis Sci 2019;96:556-67.

[13] Lam, Carly Siu Yin, et al. “Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial.” British Journal of Ophthalmology 104.3 (2020): 363-368.

[14] Yam JC, Jiang Y, Tang SM et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmol 2019;126:113-24.

[15] Gwiazda, Jane et al. Seasonal variations in the progression of myopia in children enrolled in the correction of myopia evaluation trial. Investigative Ophthalmology & Visual Science 55.2 (2014): 752-758.

[16] Brennan NA, Cheng X. Commonly Held Beliefs about Myopia that Lack a Robust Evidence Base. Eye Contact Lens 2019; 45:215-25.

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